Improving Nurse Practitioner Student Confidence … Nurse Practitioner Student Confidence and Competency Through Virtual Technology and Distance Education 4/24/2015 3 Program Schedule

Improving Nurse Practitioner Student Confidence and Competency Through Virtual Technology and Distance Education

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ImprovingNursePractitionerStudentConfidenceandCompetencyThroughVirtualTechnologyandDistance

Education

Dr. Candace Harrington, DNP, APRN, AGPCNP‐BC

Dr. Carol Ann King, DNP, APRN, FNP‐BC

Dr. Michelle Skipper, DNP, APRN, FNP‐BC

Program Purpose

• To address the increasing complexity of the primary care older population

– Multiple chronic conditions

– Polypharmacy.

• Part of ongoing AGNP and FNP student program evaluation

• Outcomes must be the same as traditional/face to face teaching


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Program Purpose

• Promote competence and confidence synthesizing principles

– Quality geriatric care

– Safe prescribing practices

– Exposure to complex patient scenarios

– In a Distance Education Setting

• FNP and AGNP students enrolled in the last clinical course

• Presented in a fully integrated distance education setting

• Student resources

• Provided by Dept. of Research and Creative Activity $500 grant

Beer’s List Pocket Card

Pain Management in the Primary Care Settings (American Pain Society)

• Teaching Faculty Support

• Ungraded pilot project but mandatory synchronous attendance

• Blackboard platform as a stand alone course shell

• SABA lectures every 2‐3 weeks in the 11 week summer semester

• Virtual Clinic cases on alternating weeks following lecture

Program Overview


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Program Schedule

Module Objectives for Psychotropic Medication Use

• Discuss basic principles for safe prescribing for elderly patients.

• Describe the categories of medications most likely to cause adverse reactions or drug interactions for the elderly.

• Identify potentially inappropriate medications for geriatric patients using BEER’s criteria

• Describe use of START and STOPP to reduce unnecessary medications


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Module Objectives forLogical Prescribing

• Define the types of behaviors usually associated with various forms of dementia

• Identify logical prescribing practices for antidepressants and antipsychotic medications

• Discuss efficacy of antipsychotic agents in dementia related behaviors

• Create the most efficacious treatment plan for dementia related behavior using history, physical, and lab findings

• Describe legal and ethical considerations for atypical antipsychotic use in dementia related behaviors

Module Objectives for Pain Management

• Explain the differences and similarities between somatic, visceral, and neuropathic pain

• Describe barriers to chronic pain management in the geriatric patient

• Evaluate pain using appropriate tools for condition and mental status

• Analyze appropriate pain therapeutic interventions and modalities specific to sources of pain

• Discuss principles of appropriate and logical analgesic prescribing considerations

• Evaluate the NPs’ ethical and legal obligations for pain management in the geriatric population


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Nurse Practitioner Virtual Clinic Experience

• Self‐paced patient assessment

• Application of information to plan care

• Evidence‐based feedback/rationale

• Includes ECGs, x‐rays, lab results, links

• SOAP note

• Cultural and Ethnic Diversity

• Limited only by our imagination!

Virtual Clinic Cases

• Complex geriatric virtual patients that correlate with clinical patients – Gero‐psychiatric conditions

– Multiple chronic health conditions

– Polypharmacy.

• Self‐paced VC provides immediate feedback to the student regarding their clinical critical reasoning.

• Virtual Cases– Post‐herpetic neuralgia with chronic pain

– Dementia with behavioral disturbances

– Pneumonia requiring antibiotics

• Antibiotic renal dosing, and consideration of warfarin therapy.


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How it works

Cast of characters- Receptionist- Preceptor- Patient

Classic patient interview/diagnostic sequence

- Chief Complaint- HPI- Review of Systems- Physical Exam- Lab Tests- Differential Diagnosis- Impression- Care Plan

The art of the question

VC Components:Conceptual

Front End- Clinic- Models- HTML Viewer- Soap Notes- Patient Information- Multimedia- Survey Links- etc.

Back end- Administrative Web Console- Case Builder- Voices/Text-to-Speech Engine


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VC Components: Technical

Front End- Unity 3D engine/web plug-in- IVONA text-to-speech engine

- Models- Rocket box- Mixamo animations- MS Kinect

Back End- Database/ MS SQL

server- Admin website- Student section- Instructor Section- Case Builder- XML web service


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Directions

- Multi-media

- Billing/Coding

- International patients

- Select-a-model

Results• A paired‐t test t(31) = ‐7.93, p=.000 two‐tailed

• Comparing differences in pre‐ and post‐summation scores.

• A statistically significant difference in scores

FNP (n=20, m=12.97, SD=3.08)

AGNP (n=12, m=16.81, SD=3.02)

Cronbach's α =.76.


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Results• The AGNP students showed more confidence entering the program than the FNP students

• Difference was negated at the end of the program

• Student feedback overwhelmingly positive

Student Feedback• “These sessions were very helpful. The

virtual clinic aspect was helpful and I would have liked more cases to practice”.

• “I thought the sessions were great and very informative about geriatric prescribing”.

• “It helped to bring pharmacology and clinical content together and focus on geriatric population when prescribing, especially as an FNP student”.

• “Wonderful and very helpful series”

We like it!


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Lessons Learned

• Synchronous and asynchronous delivery needed

• Integrated as a graded component into the final courses in both programs

• Provided exemplar for program evaluation and development

• Unexpected opportunity for faculty development

– Master SOAP notes with rationale (handouts)

• Students requested increased case complexity

• Students commented that content was seen on national certification exams

SPECIAL PIRATE NURSE THANKS VANDERBILT UNIVERSITY

SCHOOL OF NURSING FACULTY

DR. ABBY PARISH, DNP, AGNP‐BC, ASSISTANT PROFESSORDR. JENNIFER KIM, DNP, GNP‐BC, ASSISTANT PROFESSOR

Documents

Improving Nurse Practitioner Student Confidence … Nurse Practitioner Student Confidence and Competency Through Virtual Technology and Distance Education 4/24/2015 3 Program Schedule